Effectiveness of a Cognitive Based Intervention on Semantic Memory and Word Retrieval

Project Title: The effectiveness of a cognitive based intervention on semantic memory and word retrieval operations in adult’s aged 60 years and over with Mild non-clinical Cognitive Impairment (MCI).

Table of Contents

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Acknowledgments                                                                                                     2

Table of Contents                                                                                                      3

Abstract                                                                                                                    5

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Introduction                                                                                                               6

CHAPTER 1: Literature Review                                                                             7                                  

1. History of Terminology                                                                                       7
2. Classification Criteria                                                                                         7
3. MCI Subtypes                                                                                                    8
4. Diagnostic Tools: Rating Scales                                                                        9
5. Etiology and Risk Factors                                                                                 10
6. Conclusion                                                                                                        11

CHAPTER 2: Methodology                                                                                    12                         

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2.1 Literature Review Resources                                                                             12

2.2 Aims of Research                                                                                               12

2.3 Recruitment Method                                                                                           12

2.4 Inclusion/ Exclusion Criteria                                                                               13

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2.5 Experimental Design, Sample Size and Gender                                                14

2.6 Overview                                                                                                             14

2.7 Procedure                                                                                                           14

2.8 Hypothesis                                                                                                          15

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2.9 Ethics                                                                                                                  15

CHAPTER 3:  Analysis of Results                                                                         17

3.1 Table 1:Gender                                                                                                  17

3.2 Table 2:Age                                                                                                        17

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3.3 Table 3:Reaction Times to Word TypesPre and Post Intervention                   18

3.4 Table 4:Number of Positive Ranks, Negative Ranks and Ties                           20

3.5 Table 5:Z scores and Significance                                                                      21

 

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CHAPTER 4: Discussion                                                                                       23                                         

4.1 Aims                                                                                                                   23

4.2 Literature                                                                                                            23

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4.3 Strengths and Limitations                                                                                   25

 

CHAPTER 5: Conclusion                                                                                       27                      

5.1 Summary                                                                                                            27

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5.2 Future Recommendations                                                                                  27

References                                                                                                              29

Appendices                                                                                                 

Appendix A: Global Deterioration Scale (GDS)                                                        32

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Appendix B: Workbook                                                                                             33

Appendix C: Ethics Approval Form                                                                           44

• Informed Consent Letter                                                        51
• Debriefing Letter                                                                    54

 

 

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Abstract

The aim of this dissertation was to test the effectiveness of a cognitive based intervention on semantic memory and word retrieval operations in adults aged 60 years and over with Mild non-clinical Cognitive Impairment (MCI). This dissertation sought to find out if this type of intervention could be used to slow down the progression of Alzheimer’s Disease (AD) in those who have Mild Cognitive Impairment (MCI). Meyer and Schvaneveldt’s (1971) lexical decision paradigm was used to examine the internal workings of the mental lexicon, where semantics and vocabulary are stored. The experiment recorded response rate times and error rates to word and nonword pairs which were displayed on a computer screen. All the data was stored on a software known as SuperLab5 and the results were analysed using SPSS. A total number of 12 participants, both male and female took part in a repeated measures experimental design. In between the repeated measures design, participants were required to take part in a cognitive based intervention in the form of a workbook containing crosswords, for 1 hour per day. Two weeks later the same participants were re-tested using the same lexical decision paradigm. The results showed that there was a slowing of reaction times following the cognitive based intervention. This shows this type of intervention was not successful in enhancing semantic memory and word retrieval operations within this group of 12 participants. Therefore, this type of intervention would not be the best suited method at slowing down the progression of Alzheimer’s Disease (AD) in those who have MCI.

 

 

 

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Introduction

In the field of psychology and ageing, a current topic of interest surrounds the normal ageing process and the onset/early onset of Alzheimer’s Disease (AD). Researchers have placed much of the main focus on detecting Alzheimer’s Disease (AD) at its earliest stages in order to prevent or slow down the progression. This has led to the identification of a transitional stage between the cognitive changes associated with normal ageing and the cognitive decline which leads to Dementia. This stage has been termed as the brain disease Mild Cognitive Impairment (MCI), which is said to have an effect on a variety of cognitive domains, but in particular memory. Although Mild Cognitive Impairment (MCI) shares similar characteristics with Alzheimer’s Disease (AD), it does not meet the criteria set for clinically probable Dementia. Therefore, the best non-clinical way to slow down the progression is to keep mentally or socially stimulated whilst clinical trials are underway (Petersen, 2004).

This dissertation aims to test the effectiveness of a cognitive based intervention on semantic memory and word retrieval operations in adults aged 60 years and over with Mild non-clinical Cognitive Impairment (MCI). It also aims to see if this type of intervention is the best suited method at slowing down the progression of Alzheimer’s Disease (AD) in those who have Mild Cognitive Impairment (MCI).

Chapter 1 of this dissertation will review the current literature which relates to this topic and Chapter 2 will discuss the methods used to gather data for this research. Chapter 3 will provide an analysis of the results and Chapter 4 will compare the results against previous literature and will provide an overall evaluation of the research study. Chapter 5 will then conclude this research and will suggest recommendations for future research.

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CHAPTER 1:

Review of Literature

This review of literature will examine the previous research which relates to this topic, giving an evaluation and summary of each piece.

As previously mentioned, for many years, researchers have been studying the “gap” between the normal ageing process and the onset/early onset of Alzheimer’s Disease (AD). This “gap” has since become known as the intermediate stage, Mild Cognitive Impairment (MCI). The discovery of this intermediate stage is a relatively new topic which requires further research into certain areas. Some of these areas include: an agreed upon diagnostic criteria, the causes and the treatments. Without an agreed upon diagnostic criteria, it is difficult for researchers and rating scales to clarify what is categorised as Mild Cognitive Impairment (MCI) and without the known causes, it is difficult to create clinical treatments which will help alleviate symptoms or slow down the progression for those suffering from the disease. Therefore, since there is uncertainty over the causes and no clinical trials have yet been approved, the best suited method to slow down the progression is thought to be through the use of a cognitive based intervention (Petersen, 2004).

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1.1 History of Terminology

Historically, several terms have been used to describe the intermediate stage which is now known as Mild Cognitive Impairment (MCI). In 1986, The National Institute of Mental Health (NIMH) categorised deficits in memory as Age-Associated Memory Impairment (AAMI). This term was used to describe memory changes during the ageing process which were thought to be a part of normal cognition. This proved to be difficult with widespread application as the term was associated with older adult’s performance rather than the performance of younger people. This led to the re-categorisation of the term, naming it Age Associated Cognitive Decline (AACD). This time the term recognised that other cognitive domains besides memory could be affected during the normal ageing process. In more recent years, The Canadian Study of Health and Ageing defined the term as “Cognitive Decline, No Dementia” (CIND) which refers to an intermediate stage which is not severe enough to be classed as a form of Dementia. The term itself is diverse in nature in regards to cognitive dysfunction and is therefore the closest term associated with Mild Cognitive Impairment (MCI). After gaining more knowledge about the disease, Mild Cognitive Impairment (MCI) is now recognised as a brain disease which is not associated with the normal ageing process (Petersen, 2004).

 

 

1.2 Classification of MCI

Mild Cognitive Impairment (MCI) is a brain disease which involves impairment in both memory and non-memory cognitive domains. This is in contrast to the previous criteria set whereby only a memory impairment was required for a diagnosis (Roberts & Knopman, 2013). Petersen (2004) has argued that there is no set or agreed upon diagnostic criteria however, Roberts and Knopman (2013) have suggested that individuals with Mild Cognitive Impairment (MCI) share similar characteristics in the form of a cognitive decline but are essentially able to function normally during daily activities. Therefore, these people cannot be classed as demented. Albert et al (2011, as cited in Huckans, 2013) along with other researchers has refuted this idea by suggesting, like Dementia, individuals with Mild Cognitive Impairment (MCI) experience changes in daily functioning as well as quality of life. The claims from Roberts and Knopman (2013) and Albert et al (2011, as cited in Huckans, 2013) may be accurate but are heavily dependent on where a person lies on the spectrum between normal ageing and Alzheimer’s Disease (AD).

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The spectrum between normal ageing and Alzheimer’s Disease (AD) is extensive and therefore the level of cognitive and functional impairment has an impact on the varied outcomes of the disease. These diverse outcomes can be seen in the MCI subtypes (Roberts & Knopman, 2013).

1.3 MCI Subtypes

There are several types of Mild Cognitive Impairment (MCI) with the two most common forms being the Amnestic MCI (aMCI) and the Non-Amnestic MCI (naMCI). Both subtypes differ symptoms-wise but are both said to have an impact on the progression to Alzheimer’s Disease (AD). The aMCI subtype affects a single cognitive domain such as memory whereas the naMCI subtype affects one or more cognitive domains such as language, attention and visual spatial skills (Roberts & Knopman, 2013). The number of cognitive domains affected is also said to have an impact on the underlying brain disease, the severity of the disease and the progression of MCI to Alzheimer’s Disease (AD). The multi-cognitive domain subtype (naMCI) is thought to be more severe than the single cognitive domain subtype (aMCI) as the progression rate from MCI to Alzheimer’s Disease (AD) is higher (Roberts & Knopman, 2013). This was shown in a Cardiovascular Health Study which found individuals with the aMCI subtype progressed to Alzheimer’s Disease (AD) at 6 % per year while those with the naMCI subtype progressed at 16% per year (Petersen, 2004). However, when the aMCI subtype was compared against healthy individuals, those with the aMCI subtype progressed to Alzheimer’s Disease (AD) at 10-15% per year whereas the healthy individuals progressed at 1-2% per year (Petersen et al, 2001). These findings suggest that although one subtype is more likely to progress onto Alzheimer’s Disease (AD), both subtypes can lead onto Alzheimer’s Disease (AD) but at different rates of progression. Even though there is an increased risk of developing Alzheimer’s Disease (AD) no single cause or outcome of the disorder has been identified. Individuals with MCI may remain stable for years, progress onto Alzheimer’s Disease (AD) or another type of Dementia or indeed improve over time (Mayo Clinic, 2016). Due to the diverse nature, there is no fixed outcome to the disease.

1.4 Diagnostic Tools: Rating Scales

There are several useful rating scales which can be used to diagnose individuals with Mild Cognitive Impairment (MCI). The Global Deterioration Scale (GDS) was first introduced by Reisberg et al (1983) who created a rating scale to score impairment on a gradation of 1 to 7. According to Reisberg et al (1983) the scale describes the continuum from normal (1) to the more severe stages of Dementia (4-7). Individuals who score either a 2 or a 3 on the GDS are thought to have Mild Cognitive Impairment (MCI). The Global Deterioration Scale (GDS) has faced many criticisms regarding the conceptual and methodological concepts. Eisdorfer et al (1992) states the Global Deterioration Scale (GDS) was created on the basis of conscious observation of the symptoms found in people with Alzheimer’s Disease (AD) and Age-Associated Memory Impairment (AAMI). There has been no evidence over a discussion of the psychometric methods used which currently relate to the seven stages and the parameters specified on the scale. Overall, The GDS is based on assumptions about independencies between cognitive, functional and behavioural impairment. When the GDS is compared against other rating scales such as the Clinical Dementia Rating Scale (CDR) the two scales rate impairment differently. The Clinical Dementia Rating Scale (CDR) rates impairment on a scale of 0-3, with 0 being normal and 3 being the more severe stages of Dementia. Individuals who score a 0.5 or 1 on the scale are thought to have very mild Dementia or in other terms Mild Cognitive Impairment (MCI). Problems arise when trying to convert the scores from the GDS to the CDR and vice versa as there are no set rules between conversions (Choi, 2003). However, when a semi-structured interview was conducted on 78 individuals with Dementia and 36 controls, regression analysis showed a curvilinear relationship between the GDS and CDR (Choi, 2003). This may provide a way for researchers to interchange the scores between the two scales. Although, the use of a semi-structured interview requires the interpretations and conclusions to be drawn from the researcher’s own personal ability. The interpretations and conclusions drawn may be subjective and therefore inaccurate (Gubrium & Holstein, 2002). This may mean the conversions between the two are invalid and incorrect. Despite these limitations, the GDS and CDR are still regarded as useful tools to diagnose Mild Cognitive Impairment (MCI).

1.5 Etiology (Causes) and Risk Factors

As mentioned previously, the causes of Mild Cognitive Impairment (MCI) are not completely understood. It is thought that in some cases, the causes are linked to brain changes which occur in the initial stages of Alzheimer’s Disease (AD) or another type of Dementia (Alzheimer’s Association, 2017). Some of these changes have been identified in autopsies and brain imaging studies. These changes include; abnormal clumps of the amyloid protein which is associated with AD, a change in another type of protein known as Lewy Bodies which is associated with Dementia and the shrinkage of an important brain region called the hippocampus which effects memory (Mayo Clinic, 2016).

Since there is uncertainty over the causes, certain risks factors have been identified which could have an impact on the development of the disease. These risk factors can be increased with illness or lifestyle choices such as diabetes, hypertension, high cholesterol and the inability to partake in mentally or socially stimulating activities. The ageing process itself is irreversible and the risk of developing some form of Dementia increases with age (Mayo Clinic, 2017). The Alzheimer’s Association (2017) found 15-20% of adults aged 65 and over have Mild Cognitive Impairment (MCI).

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Glisky (2007) has associated increased age with lower levels of performance in cognitive functioning and tasks which involve active manipulation, decision making and problem solving. A study conducted by Dudas and Clague et al (2005) used a Face Place Test, also known as the Cambridge Face Memory Test to examine episodic and semantic memory. 22 individuals with AD and 24 individuals with MCI took part. The results showed that both AD and MCI subjects were impaired on all components including person-naming, item recognition and the recall of spatial location. These results show that subjects with MCI are impaired in both episodic and semantic memory. A limitation of the Cambridge Face Memory Test is previous research has shown individuals have difficulty in recognising faces from another ethnic group. This may provide a reason for an impairment on item recognition (Germine & Duchaine et al, 2010). The degree of the diagnosed impairment and type of memory affected may therefore be exaggerated or inaccurate. However, despite this limitation, Glisky (2007) has recognised that semantic memory is affected during ageing though it is not impaired, just slower.  Therefore, to improve the memory retrieval of individuals with Mild Cognitive Impairment (MCI), a cognitive based intervention may be used to assist cognitive functioning in older adults (Martin, 2011). Though, previous research has shown conflicting results with Gross et al (2012) stating, in advanced years, there is little benefit to be gained from cognitive training.

Meyer and Schvaneveldt (1971) claimed a variety of factors can affect a person’s ability to recall semantic information. Previous studies show that the frequency of a word can influence the recall rate. Whaley and Gordon (1978 &1983, as cited in Galambos et al, 2013) state words which are most commonly used in the English language are more likely to be recalled than words which are uncommon. Meyer and Schvaneveldt (1971) examined the effect of association between two words on recall time. 12 high school students were selected and were shown words which may either be related or unrelated semantically. Subjects were presented with four blocks of 24 test trials each. There was a total number of 16 nonword pairs, 32 word-nonword pairs, 24 pairs of associated words and 24 pairs of non-associated words. Before each trial began a fixation box appeared. After 1 second the stimulus appeared in the box prompting the subjects to press the appropriate key. The results showed that semantically related words have a priming effect on each other. Semantically related words are easier to recognise and aid the retrieval of similar words. A problem with studying semantic memory is, the items are stored serially, facilitation occurs in accessing stored information about associated words which means neural excitement in memory may be responsible for the associated effect (Schvaneveldt & Meyer,1973). Another problem with this research is the participants were all high school students, the ability to recall semantic information would not be reduced in healthy young adolescents compared to ageing individuals with Mild Cognitive Impairment (MCI) (Glisky, 2007)

6. Conclusion

This review of literature aimed to give an insight into the current thoughts and investigations into the topic of MCI. The main reasons why this topic deserves further investigation is, with life expectancy increasing, there is more chance of a larger proportion of the population suffering from a cognitive impairment (Parliament, 2010).  Once a person’s mental agility is impaired, there is an increased chance of that person developing Alzheimer’s Disease (AD). By understanding the causes and risk factors, treatments and interventions could be developed to arrest the progression of the disease. Though, researchers are currently working towards this. A decisive intervention has not yet been agreed upon and therefore more research is needed.

 

 

 

 

 

CHAPTER 2:

Methodology

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(A Quantitative Study)

This chapter will discuss how previous research has influenced the data collection for this study.

2.1 Literature Review Resources

Whilst researching for this dissertation, several types of research were reviewed, such as journal articles, medical websites and the organisations associated with reduced cognitive functioning. After analysing the literature, the information most specific to this research was selected.

After reading various pieces of literature on the subject of MCI, the aims of this particular research project were decided upon and the methods previously used were amended slightly to aid the research.

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2.2 Aims of research:

1) The aim of this research was to test the effectiveness of a cognitive based intervention on semantic memory and word retrieval operations in adults aged 60 years and over with Mild Non-Clinical Cognitive Impairment (MCI).

2)  This research also aimed to see if this type of intervention could be used to slow down the progression of Alzheimer’s Disease (AD) in those who are already suffering from Mild Cognitive Impairment (MCI).

Participants

This section will discuss the recruitment method, the inclusion/exclusion criteria and the experimental design, sample size and gender of the participants

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2.3 Recruitment Method:

All the participants selected for this study were recruited using a convenience sample. The main reason for using this type of sampling method was, with the time available for research, this method seemed most appropriate as the participants who agreed to take part were most readily available when the study commenced (Ellison et al, 2009).

 

 

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2.4 Inclusion/Exclusion Criteria

All the participants who agreed to take part in the study had to meet certain criteria before being selected. The criteria set was as follows:

• Requirement no. 1: All the participants had to be aged 60 years and over and have Mild Non-Clinical Cognitive Impairment (MCI). This was due to Plassman (1995 as cited in Salthouse, 2009) who stated cognitive decline begins around aged 60.

• Requirement no. 2: All the participants had to have English as a first language as the experiment used words which are associated with the English language, therefore individuals who grew up speaking another language may be disadvantaged or unaware of some of the words in the English vocabulary.

• Requirement no. 3: The participants must not have been diagnosed with a serious brain disorder prior to the study which could have affected the person’s ability to remember or understand words. An example of a serious brain disorder associated with an inability to remember and understand words is Alzheimer’s Disease (AD) (NHS, 2016). Furthermore, this research was aimed towards halting the progression of this disease.

• Requirement no.4:  The participants must also not have had a learning disability or barrier which effects how words are interpreted or displayed. An example of a learning barrier which effects the interpretation and display of words is Dyslexia (NHS, 2015). The difficulty in reading words would therefore invalidate the results.

• Requirement no. 5: The participants must also not be an avid user of brain training activities such as crosswords or sudoku puzzles, as the experiment is looking for an improvement following one of these types of interventions. Therefore, those who are accustomed to using puzzles may not show any change post intervention.

• Requirement no. 6:  The final requirement relates to when the experiment is underway. Before starting the experiment, the participants must not have consumed any stimulants which could advantage the participants results. Some of these stimulants include coffee, tea and energy drinks (Encyclopedia of Health, 2010). The participants were however able to eat on the day of the study.

The failure to comply to these requirements would mean the study did not use a standardised procedure for each of the participants and therefore, the results may not be accurate or a reliable source which contributes towards the research field (Eysenck, 2002).

2.5 Experimental Design, Sample Size and Gender:

A repeated measures experimental design was used as the research was looking for a change in the same participants following a cognitive based intervention (Verma, 2015). A total number of 12 participants, both male and female, took part. The sample size was chosen based on Meyer and Schvaneveldt’s (1971) study.

Experiment

This section will give an overview of the study previously used by Meyer and Schvaneveldt (1971) paradigm as this research used the lexical decision paradigm created by the two researchers. This section will also detail the three phases of the experimental procedure and predict the results of the study based on two different types of hypothesis.

2.6 Overview:

Previously, both psychologists and psycholinguists have used a Lexical Decision Task (LDT) to examine mild impairments in semantic memory. The Lexical Decision Task (LDT) is most commonly used to study the internal workings of the mental lexicon. The task requires participants to classify visual stimuli as words or non-words as quickly and as accurately as possible. Analysis is therefore primarily based on the reaction times and error rates to the visual stimuli (Meyer and Schvaneveldt, 1971).

2.7 Procedure:

There were three phases to this experiment. The procedure was listed as below:

Phase 1:

At phase 1 of the experiment, participants over the age of 60 were required to complete a Global Deterioration Scale (GDS) (see Appendix A) which identified the level of impairment. The experiment required a diagnosis of Mild Cognitive Impairment (MCI) without being medically diagnosed by a doctor and therefore the best way to do this was through the use of a rating scale. The participants who scored a 2 or a 3 on the GDS were able to participate in the Lexical Decision Task (LDT). The original Meyer and Schvaneveldt (1971) lexical decision paradigm was used.

The paradigm displayed words on a computer screen and required participants to decide if both two letter strings revealed were words or non-words. The task included 24 pairs of semantically related words (BREAD-BUTTER) and 24 pairs of semantically unrelated words (BREAD-CONCRETE). 16 pairs of non-word pairs (ELUG-TEEHS) were also used along with 32 word-nonword pairs (BREAD-TSOAST). At the beginning of each of the 24 trials, a small fixation box appeared. After 1000 milliseconds the stimuli appeared in the box, one letter string centred above the other. The participants had to decide whether the stimulus type is the same or different, both words and non-words respectively. The participants had to select the answer by pressing on the appropriate key on the keyboard. In this instance, the “Z” key represented yes and the “?/” represented no. All the participant’s reaction times and error rates were collected and stored in the software known as SuperLab 5.

Phase 2:

During phase 2 of the study, the same participants were required to engage in a cognitive based intervention that consisted of a workbook containing a series of crossword puzzles. The crosswords were expected to be completed over a period of two weeks, 1 hour per day (See Appendix B)

Phase 3:

At the final stage of the experiment, phase 3, the participants repeated the Lexical Decision Task (LDT) previously underwent to test for possible improvements in semantic memory and lexical efficiency (word retrieval). All the data was analysed by SPSS.

2.8 Hypothesis:

Two types of hypotheses are listed below:

Null Hypothesis: There will be no difference in the participant’s semantic memory and word retrieval operations post the cognitive based intervention

Alternative Hypothesis: There will be a significant difference in the participant’s semantic memory and word retrieval operations post the cognitive based intervention

2.9 Ethics

Before carrying out research on human participants, it was important to review the British Psychological Society’s code of conduct on human research (2014). Reviewing these guidelines ensured that all the information gathered from the research was carried out within the stated guidelines, reducing ethical problems. The guidelines followed are listed below and can be seen in the Ethics Approval Form (Appendix C).

Informed Consent:

All the participants who agreed to take part were handed an informed consent letter which stated the aims of the research, what the study entailed and the length of time the study was expected to last. After reading the informed consent letter, the participants had to agree to take part in the study by drawing a tick in a box at the bottom of the page. In doing this, the participants gave informed consent.

Deception:

The participants who took part in this study were not deceived as the true aims of the research were provided in the informed consent letter. In making the aims of the research clear prior to the commencement of the study, the participants fully understood what the study entailed.

Right to Withdraw:

In the informed consent letter, the participants were made aware of the ability to withdraw from the study both during and after the study had been completed. All data recorded from the participants would not be used in the final paper had any withdrawn from the study. Furthermore, the contact details of myself and supervisor were detailed on the consent form, should a wish to withdraw be expressed.

Confidentiality:

All the participant’s information was kept private and not discussed with any other participant in the study. All participants were not named and were labelled from 1-12 to ensure confidentiality.

Protection from Harm:

During the study, all participants were protected from harm due to the right to withdraw and the absence of hurtful and offensive language in the Lexical Decision Task (LDT).

Debriefing:

At the end of the study, the participants were given a debriefing letter which reiterated what the informed consent letter detailed. This was to remind the participants of the study undertaken.

 

CHAPTER 3:

Analysis of Results

This section will analyse the results obtained in the Lexical Decision Task (LDT) prior and post the cognitive based intervention. All the data was analysed using SPSS software. The significance level was set to 0.05.

3.1 Table 1

Gender
		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	Male	6	50.0	50.0	50.0
	Female	6	50.0	50.0	100.0
	Total	12	100.0	100.0

A total number of 12 participants took part in this research. 6 participants were male (50%) and 6 participants were female (50%).

3.2 Table 2

Statistics
Age
N	Valid	12
	Missing	0
Mean		72.75
Median		73.50
Minimum		60
Maximum		91

All the 12 participants were aged 60 years and over with the minimum age being 60 and the maximum age being 91. The average age of the total number of participants was 73 years (M =72.75) with the middle age being 74 years (Mdn = 73.50).

3.3 Table 3

Descriptive Statistics
WORD OR NONWORD		N	Mean	Std. Deviation	Minimum	Maximum
word vs word	REACTION TIME PRIOR TO INTERVENTION	1147	1542.44	964.679	435	8289
	REACTION TIME POST TO INTERVENTION	1151	2054.55	1699.505	536	45903
nonword vs word	REACTION TIME PRIOR TO INTERVENTION	774	1538.06	1004.848	450	8273
	REACTION TIME POST TO INTERVENTION	775	2215.53	1078.475	680	12026
nonword vs nonword	REACTION TIME PRIOR TO INTERVENTION	373	1554.61	830.780	443	5157
	REACTION TIME POST TO INTERVENTION	377	2052.47	913.716	753	6273

A nonparametric Wilcoxon Signed Rank Test was conducted to compare two related samples reaction times pre and post cognitive based intervention. Table 3 shows the reaction times of the participants to different word type pairs. Prior to the cognitive based intervention, 1147 scores for word vs word word pairs were analysed. The results showed that the minimum reaction time was 435 milliseconds and the maximum reaction time was 8289 milliseconds. The average reaction time of these scores was 1542.4 milliseconds (M = 1542.44) with a standard deviation of 964.68 (SD = 964.679).  Post the cognitive based intervention, 1151 scores for word vs word word pairs were analysed. The results showed that the minimum reaction time was 536 milliseconds and the maximum reaction time was 45903 milliseconds. The average reaction time of these scores was 2054.6 milliseconds (M=2054.55) with a standard deviation of 1699.5 (SD = 1699.505). Based on the means between both tests, the reaction times for word vs word were faster prior to the cognitive based intervention.

The reaction times prior and post the cognitive based intervention were also analysed for nonword vs word type pairs. 774 scores prior to the cognitive based intervention were analysed. The results showed that the minimum reaction time was 450 milliseconds and the maximum reaction time was 8273 milliseconds. The average between these results was 1538.1 milliseconds (M = 1538.06) with a standard deviation of 1004.85 (SD= 1004.848). Post the cognitive based intervention, 775 scores were analysed. The results showed that the minimum reaction time was 680 milliseconds and the maximum reaction time was 12026 milliseconds. The average score between these results was 2215.5 milliseconds (M= 2215.53) with a standard deviation of 1078.48 (SD= 1078.475). Again, based on the means between both tests, the reaction times for nonword vs word were faster prior to the cognitive based intervention.

The reaction times were also analysed for the nonword vs nonword word type pairs prior and post cognitive based intervention. 373 scores prior to the cognitive based intervention analysed. The results showed that the minimum reaction time was 443 milliseconds and the maximum reaction time was 5157 milliseconds. The average score between these results was 1554.6 milliseconds (M=1554.61) with a standard deviation of 830.8 (SD=830.780). Post the cognitive based intervention, 377 scores were analysed. The results showed that the minimum reaction time was 753 milliseconds and the maximum reaction time was 6273 milliseconds. The average reaction time between the two scores was 2052.5 milliseconds (M= 2052.47) with a standard deviation of 913.72 (SD= 913.716). Based on the two means between both tests, the reaction times for nonword vs nonword were faster prior to the cognitive based intervention.

Overall, the reaction times for word vs word, nonword vs word and nonword vs nonword were faster prior to the cognitive based intervention.

 

 

 

 

 

3.4 Table 4

Ranks
WORD OR NONWORD			N	Mean Rank	Sum of Ranks
word vs word	REACTION TIME POST TO INTERVENTION – REACTION TIME PRIOR TO INTERVENTION	Negative Ranks	337a	523.38	176378.50
		Positive Ranks	808b	593.70	479706.50
		Ties	1c
		Total	1146
nonword vs word	REACTION TIME POST TO INTERVENTION – REACTION TIME PRIOR TO INTERVENTION	Negative Ranks	183a	313.63	57395.00
		Positive Ranks	590b	409.76	241756.00
		Ties	1c
		Total	774
nonword vs nonword	REACTION TIME POST TO INTERVENTION – REACTION TIME PRIOR TO INTERVENTION	Negative Ranks	118a	153.14	18070.00
		Positive Ranks	255b	202.67	51681.00
		Ties	0c
		Total	373
a. REACTION TIME POST TO INTERVENTION < REACTION TIME PRIOR TO INTERVENTION
b. REACTION TIME POST TO INTERVENTION > REACTION TIME PRIOR TO INTERVENTION
c. REACTION TIME POST TO INTERVENTION = REACTION TIME PRIOR TO INTERVENTION

Table 4 shows the number of cases which have a negative rank, positive rank and ties. For word vs word, 1146 scores were analysed. The results showed that in 337 cases, the post intervention had faster response rate times than the pre intervention. The average response rate time was 523.4 milliseconds (M= 523.38). However, in 808 cases, the response rate times were slower post intervention. The average score of these cases was 593.7 milliseconds (M=593.70). There was also a tied score of 1. These results showed that although the post intervention scored favourable in 337 cases, 808 times this was not the case. Overall, the response rate times were faster prior to the intervention for the word vs word pairings.

In the nonword vs word type pairs, 774 scores were analysed. The results showed that in 183 cases the post intervention had faster response rate times than the pre intervention. The average response rate time was 313.6 milliseconds (M= 313.63). Conversely in 590 cases the response rate times were slower post intervention. The average score for these cases was 410 milliseconds (M= 409.76). There was also a tied score of 1. Overall, the response rate times were faster prior to the intervention for the word vs nonword pairings.

In the nonword vs nonword word type pairs, 373 scores were analysed. The results showed that in 118 cases the post intervention had faster response rate times than the pre intervention. The average response rate time was 153.1 milliseconds (M= 153.14). Though, in 255 cases the response rate times were slower post intervention. The average score of these cases was 202.7 milliseconds (M= 202.67). There were also 0 ties between the two tests. Overall, the response rate times for the nonword vs nonword pairings were faster prior to the intervention.

On the whole, the response rates were slower for the post intervention on all word type pairs.